Greater trochanteric-pelvic impingement
Greater trochanteric-pelvic impingement is an extra-articular or external type of hip impingement
Greater trochanteric-pelvic impingement is also known as ‘pelvitrochanteric impingement’ or ‘trochanteric impingement’ 1,2.
Greater trochanteric-pelvic impingement seems to be more common in younger people 2.
- Perthes disease
- slipped capital femoral epiphysis
- infantile coxa vara
- previous traumatic injury or hip infection
Chief complaints are pain while walking, limping decreased range of motion in the affected hip joint and/or impaired abduction 1.
Impingement is caused between the greater trochanter and the ilium or posterior rim of the acetabulum on hip abduction from full extension in patients with a shortened femoral neck. This can occur as a sequel of Perthes disease or slipped capital femoral epiphysis 1,2. Since recently previous total hip replacement has also been discussed as a possible etiology 3.
Radiographic features include the following:
- reduced distance between the greater trochanter and the ilium
- shortened femoral neck length
Treatment and prognosis
Treatment options include conservative approaches with activity modification physical and manual therapy, as well as nonsteroidal anti-inflammatory drugs. For more severe symptoms e.g. limping lateralizing osteotomy or a combination of femoral head-neck osteochondroplasty and relative femoral neck lengthening are surgical options 1.
- 1. Bech NH, Haverkamp D. Impingement around the hip: beyond cam and pincer. (2018) EFORT open reviews. 3 (2): 30-38. doi:10.1302/2058-5241.3.160068 - Pubmed
- 2. Cheatham SW. Extra-articular hip impingement: a narrative review of the literature. (2016) The Journal of the Canadian Chiropractic Association. 60 (1): 47-56. Pubmed
- 3. Isaacson MJ, Bunn KJ, Incavo SJ. Trochanteric impingement: is it a source of pain after THR?. (2015) Arthroplasty today. 1 (3): 73-75. doi:10.1016/j.artd.2015.05.004 - Pubmed
- 4. Vassalou EE, Zibis AH, Klontzas ME, Karantanas AH. Imaging of impingement syndromes around the hip joint. (2017) Hip international : the journal of clinical and experimental research on hip pathology and therapy. 27 (4): 317-328. doi:10.5301/hipint.5000526 - Pubmed
- 5. Arévalo Galeano N, Santamaría Guinea N, Gredilla Molinero J, Grande Bárez M. Extra-articular hip impingement: a review of the literature. (2018) Radiologia. 60 (2): 105-118. doi:10.1016/j.rx.2017.09.005 - Pubmed